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SPC Upward Bound Application
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Middle Name
Your answer
Last Name
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Address1
*
Your answer
Address2
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Home Phone Number
Your answer
Student Cell Phone Number
Your answer
Gender
*
Female
Male
Prefer not to say/other
Race/Ethnicity-Please check all that apply.
*
American Indian or Alaskan Native
Asian
Black or African American
Hispanic
Native Hawaiian or Other Pacific Islander
White
Required
School
*
Brownfield High School
Levelland High School
Morton High School
Smyer High School
Sundown high School
Whiteface High School
Whitharral High School
Current Grade Level
*
8th grade
9th grade
10th grade
11th grade
12th grade
Parent/Guardian Name
*
Your answer
Parent/Guardian Relationship
*
Your answer
Parent/Guardian Phone Number
*
Your answer
Parent/Guardian Work Phone Number
Your answer
Parent/Guardian Email
Your answer
Did either of your parent graduate college with a bachelors degree (4 year degree)?
*
Yes
No
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